Provider Demographics
NPI: | 1205192358 |
---|---|
Name: | DRAGON ACUPUNCTURE CLINIC |
Entity Type: | Organization |
Organization Name: | DRAGON ACUPUNCTURE CLINIC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ACUPUNCTURIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CHIUFEN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | WANG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 512-825-4979 |
Mailing Address - Street 1: | 8700 MANCHACA RD STE 505 |
Mailing Address - Street 2: | |
Mailing Address - City: | AUSTIN |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78748-5376 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 512-825-4979 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 8700 MANCHACA RD STE 505 |
Practice Address - Street 2: | |
Practice Address - City: | AUSTIN |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78748-5376 |
Practice Address - Country: | US |
Practice Address - Phone: | 512-825-4979 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-04-03 |
Last Update Date: | 2012-04-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | AC00731 | 171100000X |
TX | AC00732 | 171100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 171100000X | Other Service Providers | Acupuncturist | Group - Single Specialty |